Global medication waste management practices: challenges and opportunities in developing countries

Medication waste is synonymous with pharmaceutical waste, unused or expired medicines. Improper disposal of medication waste leads to serious personal and environmental health hazards. There were no established medication waste management programmes in most of the developing countries including Asia. Presence of unique socioeconomic problems in these counties makes the establishment of successful medication waste management programme a challenge. We reviewed the literature pertaining to the disposal of medication waste in different countries in order to understand the current status. We found that the medication waste disposal via normal sewage systems was the main method practiced in most of the countries and that the situation was much worse in developing countries. Return of unused medicines to pharmacies, which is considered to be the best method, was successfully practiced in some developed countries with established systems. Lack of proper mechanism to handle medication waste seems to be the main reason behind substandard medication waste management in developing countries. We propose a simple model for the disposal of medication waste taking into consideration the unique challenges and infra-structure issues in developing countries. International level policy and funding support, national level policy and unbiased financial allocations, institutional level comprehensive programmes according to the local requirements and most importantly the public support will make medication waste management programme a success. Furthermore, developing countries should join the on-going international forum on medication waste management. This short communication will be an eye opener for the academic key opinion leaders in developing countries to initiate medical waste management programmes in their countries

Medication waste disposal practices among patients attending selected out patient departments in a tertiary care institution: a cross sectional survey

Background: Medication waste has major implications on human and animal health, environmental safety and the health economy. Low and middle income countries have paid less attention to proper medication waste disposal at household and community level. This is the first baseline assessment on medication waste disposal practices among the general public in Sri Lanka.Methods: This was a descriptive, cross-sectional survey, conducted via face to face interviews using a structured questionnaire among selected outpatient clinics at the National Hospital of Sri Lanka. A non-probability sampling technique was used to achieve a representative sample from each clinic. The data collectors were trained prior to administering the questionnaire. Data was presented as descriptive statistics using percentages. Chi-square test was used to find associations.Results: From the total number of participants (n=200) majority were females 135 (67.5%). Majority of the participants (78%) stated that they have unused medicines at home. Among them, tablet form was the commonest (78%) followed by topical preparations (49%). Commonest reason for having unused medicines at home were self-discontinuation as illness resolved (57.5%). There was a significant difference between the knowledge and practices when disposing tablet form (<0.001), syrups (0.002), topical preparations (0.04) and sharps (<0.001). Majority (23%) discarded sharp to rubbish bins. Rubbish bin was the commonest mode of disposal for all dosage forms as well as devices.Conclusions: In this sample majority had unused medicines at home which was compatible with the pattern seen in other countries and need proper attention

The concurrent association of inflammatory polymyositis and Crohn’s ileo-colitis in a Sri Lankan man: a case report of a rare association and literature review

BACKGROUND: Crohn’s disease is a relapsing, systemic inflammatory disease affecting the gastrointestinal tract with associated extraintestinal manifestations and immune disorders. Among the few cases reported, the association of Crohn’s disease with polymyositis varies in its complexity and severity. We report here the first known case of inflammatory polymyositis leading to rhabdomyolysis in a male patient diagnosed with Crohn’s ileocolitis. CASE PRESENTATION: A 42-year-old previously healthy man presented with acute polymyositis leading to rhabdomyolysis. The acute nature of the illness raised the suspicion of an infective, toxic, or metabolic insult, which was excluded during further investigations. Prolonged low-grade fever and raised inflammatory markers led to the suspicion of inflammatory polymyositis, which was confirmed by electromyography and muscle histology. In the absence of an infective cause, the concurrent association of prolonged diarrhea containing blood and mucous after recovery from an acute phase of myositis proved a diagnostic challenge. Ileocolonoscopy findings of extensive aphthous ulceration with skip lesions extending to the terminal ileum, and histology showing polymorph infiltration of the lamina propria, transmural involvement, and micro abscess formation was suggestive of Crohn’s disease. Sensory motor axonal peripheral neuropathy, which is another rare association of inflammatory bowel disease, was also present. CONCLUSION: An unrecognized genetic predisposition or altered gut permeability causing disruption of the gut immune barrier triggering an immune response against skeletal muscles may have contributed to this unique association. Both polymyositis and Crohn’s ileocolitis responded well to corticosteroids and azathioprine, which is supportive of their immune pathogenesis. Myositis can be considered to be a rare extraintestinal manifestation of Crohn’s disease and can be used in the differential diagnosis of corticosteroid or hypokalemia-induced myopathy in Crohn’s disease

A survey on the knowledge, perceptions and practices regarding unwanted medicine disposal among pharmacists in Sri Lanka

Background: Unwanted medicines are defined as expired, unused, damaged or contaminated pharmaceutical products. Improper disposal of unwanted medicines leads to many health and environmental hazards. The World Health Organisation recommends that unwanted medicines should always be disposed properly. The main objective of this study was to assess the knowledge, practices and perceptions on the disposal of unwanted medicines among pharmacists in Sri Lanka.Methods: A cross-sectional study was carried out among pharmacists in 40 private retail pharmacies in the Northern, Eastern and the Western provinces within a period of three months. The pharmacies were selected via stratified randomised sampling in each district. The most experienced pharmacist in each pharmacy was recruited for data collection. A pre-tested, self-administered questionnaire was used. The ethics approval was obtained (Ref: EC-12-190). The data was represented using simple descriptive statistics.Results: The data was collected from 40 pharmacies. Among the pharmacists, 65% were males. The majority answered that burning and landfill as the most appropriate methods of disposal for most of the types of medicinal waste. A significant number of pharmacists were not aware about the method of disposal for anti-infective agents and anti-neoplastic agents. The majority perceived the seriousness of environmental damage caused by disposal via trash or sink. A majority was not agreeing to have pharmacies as collecting centers for unwanted medicines. A discrepancy between the pharmacists’ perceptions and the practices was observed.Conclusions: The level of knowledge, practices and perceptions among pharmacists on unwanted medicines disposal was substandard and needs attention

Anatomical relations of the superficial sensory branches of the radial nerve: a cadaveric study with clinical implications

Abstract Background Anatomically, it is difficult to give a systematic description of the superficial branch of the radial nerve (SBRN). Our aim was to describe the exact relationship of the SBRN to fixed bony points of radial styloid and Lister's tubercle, and to the cephalic vein. We also compared our data with other international studies. Methods The study was a descriptive anatomical study. Twenty-five forearms were dissected. Measurements were made from predefined fixed reference points. Results The mean distance to the point of emergence of the nerve from the radial styloid was 8.54 cm (SD = 1.32). The nerve branched at a mean distance of 5.57 cm (SD = 1.43) from the radial styloid. The mean distance to the point where the most medial and most lateral branches of the nerve crossing the wrist joint, measured from the Lister's tubercle were 2.51 cm (SD = 0.53) and 3.90 cm (SD = 0.64). In 17 specimens(68%) cephalic vein crossed the SBRN superficially once. Mean distance from the radial styloid to the most distal point where the vein crossed the nerve was 5.10 cm. Diffefrence between mean distance to the point of emergence and branching point, when compared with other international studies were not statistically significant. (P value > 0.05) Conclusions We recommend avoiding transverse incisions in the snuffbox region between 2.51 cm and 3.90 cm from the Listers tubercle. We also recommend avoiding cannulation of the cephalic vein in the distal forearm.</p